Children present unique difficulties when coming for surgery. They may not always understand the need for an operation and their fears are often very different from what adult patients fear. Some of the following information may be helpful in getting yourself and your child for ready surgery.
In many cases children fear what adults fear: discomfort and pain, not waking up after surgery, and/or waking up while the surgery is still happening. Children are less able to express their fears, though, and may fear simply being away from their parents.
In most cases, the best preparation for your child is to be as honest and open with him or her as you can, and explain things in an age-appropriate manner. Assure your child that he or she will be asleep during the procedure and will wake up at the end and be reunited with you. Answer questions as directly as possible; your child will take his or her cues about the surgery from your own attitude and behavior. The more confident you are the more confident your child will be. Discuss your own questions and concerns with the surgeon and the anesthesiologist.
The day can generally be split into three distinct periods: preoperative, intraoperative, and postoperative.
In the morning, after arriving at the hospital, you and your child will be directed to the surgery center and the preoperative holding area. Once there you will be greeted by a nurse who will check your child's heart rate and temperature, review the surgical plan and your child's history, and confirm that everything is in order. You will also meet with the anesthesia providers at this time and they can answer any other questions you or your child may have. It's important to remember that your child will be receiving his or her cues about the situation from your own feelings: if you are confident, understand the procedure, and prepared for the day it will help your child to be confident, too.
Adolescents and older children can often have an IV placed at this point. When possible and when our patients are agreeable this is our preferred approach. We will try to numb up the skin so that the IV doesn't cause much discomfort (like we do with all patients). The benefit of having an IV is that we can give IV medications for relaxation and we can use the IV to go to sleep with once we are in the operating room.
Younger children and adolescents with a lot of anxiety about the IV may be offered a "mask induction" when it is considered safe by the anesthesiologist. This means that we wait and start the IV after the child is asleep in the operating room, instead having him or her breath in a mask to go to sleep. Often the anesthesiologist can bring the mask out for the child to become familiar with and reduce anxiety. Additionally, a dose of medication can be given by mouth to help the child relax and ease the anxiety of leaving his or her parents.
As a policy, parents are not permitted in the operating room with their children, so once some sedation has been given and the anesthesiologist feels your child is ready , he or she will be taken to the operating room by the anesthesia team. This can be a difficult time for parents, but know that the team will be with your child from the moment they leave your care through the entire surgery and into the recovery area.
In the operating room the anesthesia team will place monitors and get your child comfortable, all the while explaining what is happening and providing as much support and encouragement as they can. Often a favorite blanket or toy can be brought to the OR and may help alleviate some of the anxiety. After the child is asleep, the anesthesia team will stay with him or her and closely watch the vital signs, hydration, comfort, and sedation through the surgery.
Once the surgery is completed, your child will be awakened and taken to the recovery room by the anesthesia team. We will be giving pain medication as needed for comfort and assuring your child that he or she is okay. The recovery room attempts to bring parents back to be with their children as soon as possible.
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